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Quintessence Publishing: Journals: ORTHODONTICS
The Art and Practice of Dentofacial Enhancement

Formerly World Journal of Orthodontics

Edited by
Rafi Romano, DMD, MSc (Editor-in-Chief)

ISSN 2160-2999 (print) / ISSN 2160-3006 (online)

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Fall 2002
Volume 3 , Issue 3

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Changes Occuring During and After Treatment of Class III Malocclusion with Rapid Palatal Expansion and Face Mask

Marida Benedetti, DDS1, Carles Bosch, MD, DDS, MS, PhD2, Birte Melsen, DDS, Dr Odont3

Editor’s Note: Protraction and retraction extraoral force has been used for some time by a limited number of orthodontists. But there has been a significant increase in the use of rapid palatal expansion for transverse arch deficiencies. For decades, the arguments waxed and waned on expansion and the conflict with the neuromuscular envelope. Confronted with predominance of the morphogenetic pattern, the ultimate stability of the therapeutic result was questioned by many clinicians for both growth guidance and expansion therapy. Controversy has been the order of the day as far as basal sagittal corrections for Class III malocclusions, in particular. Early treatment of Class III malocclusions has been questioned by many clinicians, opting to wait for the permanent dentition, and potential use of orthognathic surgery. Mixed-dentition treatment is still a “no-no” in the majority of orthodontic practices. This article faces the challenges head-on, with a study of 23 patients from 4 to 10 years of age, characterized by a Class III malocclusion and a narrow maxillary arch, with records taken before treatment, after 6 to 9 months of RPE and face mask, and at 2 to 9 years after treatment. Despite the dental correction being maintained, the original growth pattern caught up in the majority of patients. Vertical changes had a tendency to return after treatment. The authors conclude that on a cost-benefit basis, therapy was still justified, even for those cases that later demonstrated significant mandibular growth. The question raised for me, after treating so many Class III cases, is that two-phase treatment with orthopedic guidance might be the way to approach these problems, even as the orthopedic surgeon does with skeletal growth guidance for long bones, or treating scoliosis. The idea of encapsulating therapy to as short an interval as possible, ignoring the need for growth guidance procedures, is not consistent with optimal growth guidance efforts, ie, treating patients when they grow. This is fine for tooth movement but inconsistent with growth guidance potential. We orthodontists have to realize that we are facial orthopedists for skeletal, ie, basal maxillomandibular, abnormalities. My clinical experience confirms this approach, with two or three periods of growth guidance, starting as early as 2 to 3 years of age, and timed with the prepubertal and pubertal growth periods, as indicated. Long-term control will produce the best possible, and most stable, results.—T.M. Graber

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